摘要
目的 探讨八式太极拳训练对膝骨关节炎(KOA)不同疼痛反应患者登梯时下肢关节负荷的影响,并分析疗效差异的原因。方法 回顾性选取完成12周(每次60 min,每周2次)杨氏八式太极拳干预的KOA患者54例,根据干预前后视觉模拟评分法(VAS)减少≥1.8 cm者纳入反应者组,<1.8 cm者纳入非反应者组。比较两组患者干预前后VAS评分结果;采用三维运动分析系统对两组患者干预前后上梯、下梯时的步态进行分析,包括上梯、下梯步速,髋关节、膝关节、踝关节在三个运动平面(矢状面、冠状面及水平面)上的肌力矩最大值及其范围,计算髋关节、膝关节、踝关节总负荷大小。采用Spearman相关性分析方法探究干预前后疼痛变化量与干预前后有显著性差异的关节负荷指标的关系。结果 与本组干预前比较,两组患者干预后VAS评分均降低(P<0.05或P<0.01),反应者组VAS评分干预前后差值高于非反应者组(P<0.01)。与本组干预前比较,反应者组干预后上梯的步速显著提高,下梯时髋关节总负荷下降(P<0.05);非反应者组干预后上梯、下梯步速差异均无统计学意义(P>0.05),下梯时踝关节总负荷减小(P<0.05)。反应者组患者干预前后上梯膝关节总负荷差值及下梯踝背屈跖屈肌力矩范围差值均低于非反应者组(P<0.05)。相关性分析显示,干预前后疼痛变化量与下梯时踝背屈跖屈肌力矩范围变化量呈负相关(r=-0.346,P<0.05)。结论 八式太极拳训练可改善KOA患者下肢关节负荷,尤其对疼痛改善明显者膝关节、踝关节负荷影响明显,且疼痛缓解程度与踝关节负荷改善密切相关。
Objective To explore the impact of eight-form Tai Chi training on lower limb joint load during stair climbing in patients with knee osteoarthritis(KOA)who exhibit different pain responses,and to analyze the reasons for differences in therapeutic effects.Methods A total of 54 KOA patients who completed a 12-week intervention of YANG-style eight-form Tai Chi(60 minutes per session,twice a week)were selected retrospectively.Patients with a reduction≥1.8 cm in Visual Analogue Scale(VAS)score after the intervention were included in the responder group,while those with a reduction<1.8 cm were included in the non-responder group.VAS scores of both groups before and after the intervention were compared.A three-dimensional motion analysis system was used to analyze the gait of both groups during stair ascent and descent before and after the intervention,including parameters such as stair ascent/descent speed,maximum muscle torque and torque range of the hip,knee,and ankle joints in three movement planes(sagittal,coronal,and horizontal planes).The total load of the hip,knee,and ankle joints was calculated.Spearman correlation analysis was applied to explore the relationship between the amount of pain change(before and after intervention)and the joint load indicators that showed significant differences before and after the intervention.Results Compared with pre-intervention values within each group,VAS scores of both groups decreased after the intervention(P<0.05 or P<0.01),and the difference in VAS scores(pre-vs.post-intervention)in the responder group was higher than that in the non-responder group(P<0.01).In the responder group,stair ascent speed significantly increased and total hip joint load during stair descent decreased after the intervention compared with pre-intervention(P<0.05).In the non-responder group,there was no statistically significant difference in stair ascent or descent speed after the intervention(P>0.05),but the total ankle joint load during stair descent decreased(P<0.05).The difference in total knee joint load during stair ascent(pre-vs.post-intervention)and the difference in ankle dorsiflexion-plantarflexion muscle torque range during stair descent(pre-vs.post-intervention)in the responder group were both lower than those in the non-responder group(P<0.05).Correlation analysis showed that the amount of pain change(before and after intervention)was negatively correlated with the change in ankle dorsiflexion-plantarflexion muscle torque range during stair descent(r=-0.346,P<0.05).Conclusion Eight-form Tai Chi training can improve lower limb joint load in KOA patients,with a more significant impact on knee and ankle joint load in patients who show obvious pain relief.Moreover,the degree of pain relief is closely correlated with the improvement of ankle joint load.
作者
侯美金
吴思玲
柴雅泰
郑佳琪
黄小菲
张涵婧
王芗斌
HOU Meijin;WU Siling;CHAI Yatai;ZHENG Jiaqi;HUANG Xiaofei;ZHANG Hanjing;WANG Xiangbin(Rehabilitation Industry Research Institute,Fujian University of Traditional Chinese Medicine,Fuzhou,350122;National and Local Joint Engineering Research Center for Rehabilitation Medical Technology;School of Rehabilitation Medicine,Fujian University of Traditional Chinese Medicine)
出处
《中医杂志》
北大核心
2025年第24期2564-2572,共9页
Journal of Traditional Chinese Medicine
基金
国家自然科学基金(82405535,82074515,81774384)。
